The following article is a part of conference coverage from AHA Scientific Sessions 2020, held virtually from November 13 to 17, 2020. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA 2020.


Higher fitness levels were found to lower and delay the risk for atrial fibrillation (AF) among African American male veterans, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020.1

Researchers identified 11,216 African American male veterans (mean age, 58 ± 11 years) who completed a symptom-limited exercise treadmill test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, California. No participants showed evidence of ischemia or AF during or prior to the test.

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Four fitness groups were created based on age-specific quartiles of peak metabolic equivalents (METs) that were achieved by the veterans: least-fit, 4.4±1.2 METs (n=2530); moderate to fit, 6.6±1.3 METs (n=3361); fit, 8.1±1.4 METs (n=2719); and high-fit, 11.2±2.4 METs (n=2606).

Participants with AF were identified from the Computerized Patient Record System database using International Classification of Diseases coding and verified by 2 investigators. Cox proportional hazard models adjusted for age, cardiovascular disease, cardiovascular medications, and risk factors were used to assess the association between cardiorespiratory fitness (CRF) and AF.

The study’s mean follow-up was 10.7±6.2 years. During that time, 1423 participants had AF (16.6% in the least-fit group; 10.9% in the moderate to fit group; 11.9% in the fit group; and 12% in the high-fit group). The association between CRF and AF was found to be inverse, graded, and independent of comorbidities.

The risk for AF was 29% lower in the moderate to fit vs least-fit group (hazard ratio [HR], 0.71; 95% CI, 0.62-0.82; P <.001). The risk for AF was 37% lower (HR, 0.63; 95% CI, 0.54-0.73; P <.001) and 51.0% lower (HR, 0.49; 95% CI, 0.42-0.57; P <.001) among fit and high-fit vs least-fit patients, respectively.

“Engaging in physical activity to increase fitness is an inexpensive and practical intervention that healthcare professionals can prescribe to patients to prevent and manage cardiovascular disease,” noted the study’s lead author Apostolos Tsimploulis, MD, a cardiology fellow at the State University of New York at Stony Brook.2 “All of our evidence suggests the health benefits associated with increased cardiorespiratory fitness and reduced risk [for] AF are the same for all adults regardless of race.”

According to Dr Tsimploulis, the precise cause of AF was not determined in the cohort. The study was limited in that, CRF was measured only once, the level or frequency of physical activity was not assessed, and follow-up data regarding changes in cardiorespiratory fitness or physical activity were not available.

“We cannot make associations between AF and frequency, intensity, duration, or volume of physical activity,” Dr Tsimploulis added.2 “Future studies are needed to document the effects of cardiorespiratory fitness on the incidence of AF, and the studies must include women.”

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  1. Tsimploulis A, Faselis C, Rashba EJ, et al. Cardiorespiratory fitness and atrial fibrillation risk in African American veterans. Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation P687.
  2. Higher fitness levels linked to lower AFib risk in male, African American veterans [news release]. Dallas, Texas: American Heart Association; November 9, 2020. Accessed November 9, 2020.

This article originally appeared on The Cardiology Advisor